Title: Effect of 12 weeks structured exercise training on Insulin resistance in type 2 diabetes mellitus:  A Pre-Post study
Abstract:
Background: Type 2 diabetes mellitus (T2DM) is one of fastest growing noncommunicable diseases worldwide, and its prevalence is increasing rapidly around the world parallel to increase in the obesity. According to International Diabetes Federation atlas (7th edition), 415 million adults worldwide have diabetes mellitus, and it is projected to increase to 642 million by the year 2040. Type 2 diabetes mellitus (T2DM) is characterized by elevated glucose levels in circulating blood, caused by impairment in glucose tolerance development of insulin resistance & relative insulin deficiency. Impaired glucose control & Insulin resistance are reported to be a risk factor for the development of cardiovascular diseases. Insulin resistance is commonly associated with visceral adiposity, glucose intolerance, hypertension, dyslipidemia, endothelial dysfunction and elevated markers of inflammation. In Indian population, Insulin resistance is one of the strong reason for altered glycemic control, even though exercise training is found to be effective in glycemic control along with the standard medical care. There is a dearth of literature in the effectiveness of exercise training on insulin resistance in type 2 diabetes mellitus.
Aim:  
•	To find out the effectiveness of structured exercise program on insulin resistance by using Fasting insulin level and Homa-IR in Type 2 diabetes mellitus.
•	To find out the effectiveness of structured exercise program on Glycaemic control by a HbA1c method in Type 2 diabetes mellitus.

Method: We conducted a pre-and- post study with no control group. A total of 17 participants were included aged 30-75 years who are with Type 2 diabetes mellitus  on oral hypoglycemic agent with or without Insulin therapy and Exclusion criteria was participants with type 1 diabetes mellitus, known case of Respiratory disease, Coronary artery disease, Neurological disorders, Musculoskeletal problems that would interfere with the exercise training . All participants were screened at Diabetic Foot clinic, Department of Physiotherapy, Manipal University, Karnataka, India. All participants were screened clinically & biochemically and given a set of structured exercise program 3 times a week for 12 weeks along with standard medical care. The exercise protocol included warm-up by stretching and flexibility exercises for 10 min. It mainly consisted of aerobic and resistance exercise like-brisk walking for 45 mins, jogging, weights for upper and lower body major muscle groups  with maximum intensity 60% increase in heart rate and then stretching in the seated position for 10 min.The baseline data was collected before the intervention and progression of exercise program done after 6 weeks. At 3rd month all the participants were reassessed for fasting insulin level and fasting blood sugar. Resistance to insulin was assessed using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Fasting insulin level and Fasting blood sugar.
Results: The mean age of the participants was 59.23 ± 8.38 years, mean duration of diabetes was 10.82 ± 7.82 years, mean Body mass index was 26.64 ± 4.09. Significant differences have been observed in Insulin resistance, Fasting blood sugar. The current exercise protocol has been effective in lowering fasting glucose (p =0.005), Fasting insulin (p = 0.000) and insulin resistance (p = 0.005). 
Discussion: There is now suggestive evidence supporting the use of 12 weeks of structured exercise program training three times a week was effective on insulin resistance and glycemic control in T2DM patients.   Several factors could affect the exercise outcome on glucose and insulin plasma levels and insulin resistance in T2DM. 
Acknowledgement: World Diabetes Foundation (WDF 15-941) Diabetic foot care: Stepping Ahead

Effect of 12 weeks structured exercise training on insulin resistance in type 2 diabetes mellitus: a pre-post study